and Winnie Palmer Hospital for Women and Babies
(WPH) are located on the same campus. Together,
ORMC and APH admit approximately 5,000 trauma
patients annually. ORMC is staffed around the clock
by an in-house attending trauma surgeon/surgical
intensivist, as well as four general surgery residents.
ORMC and APH each have one operating room (OR)
open throughout the night. A busy academic teaching hospital, ORMC supports a variety of training and
fellowship programs, including general surgery, orthopaedic surgery, emergency medicine, internal medicine,
pediatrics, obstetrics and gynecology, surgical critical
care, medical critical care, colon and rectal surgery,
and acute care surgery.

For the last 20 years, ORMC has continuously
developed and refined its mass casualty intake plan
largely due to central Florida’s propensity for hurricanes and tornadoes, as well as the city’s status as
an international tourist destination. ORMC holds
monthly “trauma alert” training drills with local
EMS agencies, and three months before the Pulse
mass shooting, the facility participated in a tri-county
active shooter scenario mass casualty intake drill.
Most of the trauma patients to whom ORMC health
care professionals provide care have been involved
in motor vehicle crashes or falls, although it is not
uncommon for the ORMC trauma team to admit
anywhere from four to six gunshot victims per night.
Data from our American College of Surgeons Trauma
Quality Improvement Program (ACS TQIP®) registry
demonstrates a penetrating trauma rate of 10 percent
to 15 percent.

ORMC’s response

At approximately 2:00 am, the Orlando Fire Department notified the ORMC operator that an active
shooter situation was occurring in the vicinity of
the hospital. An estimated 10 minutes later, the first
victim arrived in the ORMC emergency department
(ED) with a gunshot wound to the abdomen, followed
by three patients with gunshot wounds to the chest.
Chadwick P. Smith, MD, FACS, a coauthor of this
article, was the attending trauma surgeon on call.
Dr. Smith rushed to the trauma bay, arriving as the
second victim was rolled into the room. Dr. Smith
was assisted by four on-call general surgery residents:
Joshua Corsa, MD; Aura Fuentes, MD; Nicholas Sakis,
MD; and Shalini Golla, MD. EMS officials notified the
hospital that a mass casualty incident with up to 20
victims had occurred. The ORMC ED was immediately placed on lockdown due to the active shooter
situation a few blocks away.

At around 2: 20 am, while directing the ongoing
resuscitation of multiple victims, Dr. Smith started to
become aware of the magnitude of the mass casualty
intake event, and he summoned additional trauma
surgeons, Joseph A. Ibrahim, MD, FACS, and Michael
L. Cheatham, MD, FACS (co-authors of this article),
to the trauma bay. Patients began arriving at ORMC
at a rate of approximately one per minute, initially
brought in by foot, private vehicle, police car or van,
and subsequently by ambulance. As the number of
victims steadily increased, Dr. Smith called trauma
surgeons Matthew W. Lube, MD, FACS, and William
S. Havron III, MD, FACS (co-authors of this article), to